<p>link on #38 “The Invisible Gorilla…” is available as an Ebook in my public library.</p>
<p>"I think I’d feel better if they were read in India. (I’m being perfectly serious - because of the larger number of health conditions that Indian physicians deal with, I think they would be more likely to look for the “unusual”. "</p>
<p>I would not trust a CT read in India more than a CT read in the US. The subset of conditions and diseases Indian radiologists are dealing with is quite different from what is prevailent in the US (e.g., it would not be uncommon for a person to suffer from pulmonary TB while in the US, thank goodness, there is no TB health crisis - yet). Also, re: reasons why U.N. missions in Africa are employing fewer and fewer U.S. physicians and more trained in India and elsewhere - the answer is simple. Infectious diseases. How many cases of TB, cholera, etc. does a typical doctor see in the US? When it comes to practicing medicine, IMO, paper education is not as valuable as real world experience.</p>
<p>
</p>
<p>Radiologists in practice undergo frequent review, live in fear of malpractice litigation, and receive constant feedback from other clinicians about their imaging technique and interpretations. Acquiring a bad reputation and losing referrals or contracts is the kiss of death for a radiologist.</p>
<p>Because images are stored indefinitely and can be reviewed at any time, practicing radiologists, including off site physicians, face a very high bar for performance.</p>
<p>Well, obviously the fear isn’t so great that it prevents them from cheating. Kiss of death from a bad reputation? You mean cheating on an exam to obtain certification doesn’t sully their reputation? And since we know that under the pressure of time and money they DO take shortcuts (see “The Invisible Gorilla”), what’s the problem? </p>
<p>"(e.g., it would not be uncommon for a person to suffer from pulmonary TB while in the US, thank goodness, there is no TB health crisis - yet)"</p>
<p>That’s the whole point of the book: radiologists WOULD, in the early stages of an epidemic, miss cases of pulmonary TB precisely because they’d be unaccustomed to looking for it, and in the crush of time and money and “standard practice”, would often miss it. </p>
<p>“How many cases of TB, cholera, etc. does a typical doctor see in the US? When it comes to practicing medicine, IMO, paper education is not as valuable as real world experience.”</p>
<p>Again, that’s the whole point. If you become unaccustomed to looking (and have a history of taking shortcuts), you aren’t as likely to see it when it rears its head.</p>
<p>As I understood the business about the test itself, the test often contains unusual cases, those of a kind a radiologist might not often encounter. The would-be certified radiologists were cheating to get around precisely this kind of case. Why would I want them to have something on their wall or website indicating that they deliver the highest quality care?</p>
<p>Exactly my point: there is no epidemic of TB in the US, but there is plenty of other stuff going on that is not as prevailent in countries such as India and therefore may not be recognized by an Indian-trained radiologist because they are not used to seeing such conditions. Therefore, I prefer my images to be read by a specialist who is familiar with diseases/conditions I most likely to suffer from.</p>
<p>BTW, radiology would be the last means that will be used to diagnose rapidly spreading diseases; there are other specialized ways of doing this, mostly being developed by the Western docs and tested in collaboration with African specialists.</p>
<p>My personal experiences with Indian-trained physicians who immigrated here and got their licenses to practice medicine in the US were not that great - my conditions were all “Western”.</p>
<p>TB xray findings are classic teaching material for radiologists, internists and medical students. With the advent of AIDS, TB remains high in the differential diagnosis.</p>
<p>In private practice, reputation is function of outcome and demeanor. Virtually all practicing radiologists are board certified; the unknowns of how many times someone sat for an exam or what study methods were used simply do not factor into “reputation.”</p>
<p>Well, all practicing radiologists who cheated on the certification exams shouldn’t be board certified, should they? (specifically, if passage of the exam is precisely what provides them with board certification.)</p>
<p>If virtually practicing radiologists are board certified, and lots of them cheated to get there, don’t you consider there to be a problem? Or is it like the kids who cheated on their SATs? After all, the colleges didn’t mind; the College Board doesn’t seem to mind; the parents of their kids are satisfied…</p>
<p>“Therefore, I prefer my images to be read by a specialist who is familiar with diseases/conditions I most likely to suffer from.”</p>
<p>And your reasoning would endanger your life and health because the unlikely conditions - often very dangerous ones - are precisely those that it is demonstrated that radiologists are likely to miss. (And cheating on an exam where they would be shown unusual conditions wouldn’t make it any better, do you think?</p>
<p>^
In my mind, it is absolutely a problem that cheating appears to be rampant. As to stripping certification from those who have cheated: I’m not sure how they could determine who, in fact, had cheated (that would be expensive, among other things, even if it were possible to determine for the most recent exam, much less do it retrospectively). </p>
<p>Also, I think My$0.02 is, as it were, right on the money with the following:</p>
<p>
</p>
<p>Don’t get me wrong: IMO, the American Board of Radiology should immediately devise a plan to fix the exam and the way it administers the exam. It should also put a plan in place to assess the impact of all this on patient care and to redress any deficits they find. They should publicly communicate their plans. If I were on the board’s PR staff, not to mention any peer-advisory group they may have, I would be banging on tables about this. Maybe I should drop them a line?</p>